14D2144399 CLIA NUMBER - SYMETRIA - CHICAGO OTPT REHAB & SUBOXONE CLINIC

Laboratory Demographics

CLIA Number: 14D2144399

Facility Name: SYMETRIA - CHICAGO OTPT REHAB & SUBOXONE CLINIC

Facility Address:
3934 N LINCOLN AVE
CHICAGO, IL
ZIP 60613
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Facility Phone Number: 773 549-1700

Facility Type: Other - OPIOID TREATMENT PROGRAM

Certificate Type: Waiver

NPI Number: 1457892432

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	14D2144399
LAB Type	Other - OPIOID TREATMENT PROGRAM
Facility Name	SYMETRIA - CHICAGO OTPT REHAB & SUBOXONE CLINIC
Street	3934 N LINCOLN AVE
City	CHICAGO
State	IL
ZIP	60613
Phone	773 549-1700
CertificateType	4
CertificateEffectiveDate	2/15/2024
CertificateExpirationDate	2/14/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024